Healthcare Provider Details

I. General information

NPI: 1801709464
Provider Name (Legal Business Name): IZABELLA ANNA FRASER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 WASHINGTON ST
WALPOLE MA
02081-2404
US

IV. Provider business mailing address

22 ELYSE DR
NEW CITY NY
10956-3335
US

V. Phone/Fax

Practice location:
  • Phone: 508-208-8438
  • Fax:
Mailing address:
  • Phone: 845-800-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTL36956
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: